ICU经口气管插管老年糖尿病患者口腔黏膜压力性损伤的影响因素分析-现代医学

ICU经口气管插管老年糖尿病患者口腔黏膜压力性损伤的影响因素分析

单位：1. 上海市东方医院综合监护室, 上海 200000;
2. 上海市东方医院外科监护室, 上海 200000;
3. 上海市东方医院护理部, 上海 200000

分类号：R473;R587.1

出版年·卷·期（页码）：2026·54·第六期（931-937）

摘要：

目的：分析重症监护病房(ICU)经口气管插管老年糖尿病患者口腔黏膜压力性损伤(OMPI)的影响因素。方法：回顾性分析2023年10月至2025年12月期间在我院ICU经口气管插管的240例老年糖尿病患者的临床资料，依据OMPI发生情况分为OMPI组(n=74)和无OMPI组(n=166)。比较OMPI组和无OMPI组临床资料，多因素Logistic回归分析经口气管插管老年糖尿病患者发生OMPI的影响因素，采用受试者工作特征(ROC)曲线分析各影响因素及联合评估经口气管插管老年糖尿病患者发生OMPI的价值。结果：相对于无OMPI组，OMPI组糖尿病相关并发症史比例更高，急性生理学与慢性健康状况评估Ⅱ(APACHE Ⅱ)评分更高，白蛋白(ALB)水平、血细胞压积(HCT)和同型半胱氨酸(HCY)水平更低，差异有统计学意义(均P＜0.05)；多因素Logistic回归分析显示，有糖尿病相关并发症史(OR=2.481，95%CI 1.011～6.087)、APACHE Ⅱ评分(OR=1.068，95%CI 1.013～1.126)和HCY水平(OR=1.735，95%CI 1.436～2.096)越高，ICU经口气管插管老年糖尿病患者OMPI的发生风险越高，差异有统计学意义(均P＜0.05)。ALB水平(OR=0.868，95%CI 0.813～0.926)和HCT水平(OR=0.775，95%CI 0.668～0.899)越高，ICU经口气管插管老年糖尿病患者OMPI的发生风险越低，差异有统计学意义(均P＜0.05)。ROC分析显示，糖尿病相关并发症史、APACHE Ⅱ评分、ALB水平、HCT和HCY水平联合检测评估经口气管插管老年糖尿病患者发生OMPI的曲线下面积(AUC)为0.946(95%CI 0.919～0.986)。结论：糖尿病相关并发症史、APACHE Ⅱ评分、ALB水平、HCT及HCY水平是ICU经口气管插管老年糖尿病患者发生OMPI的影响因素。临床可据此采取相应措施，以良好控制并预防OMPI的发生。

Objective: To analyze the influencing factors of oral mucosal pressure injury(OMPI) in elderly patients with diabetes undergoing orotracheal intubation in the intensive care unit(ICU).Methods: A retrospective analysis was conducted on the clinical data of 240 elderly patients with diabetes who underwent orotracheal intubation in our hospital from October 2023 to December 2025. According to the occurrence of OMPI, they were divided into an OMPI group(n=74) and a non-OMPI group(n=166). The clinical data of the two groups were compared, and multivariate Logistic regression was used to analyze the influencing factors of OMPI in elderly patients with diabetes undergoing orotracheal intubation. The receiver operating characteristic(ROC) curve was used to analyze the value of each influencing factor and their combined assessment for the occurrence of OMPI in elderly patients with diabetes undergoing orotracheal intubation.Results: Compared with the non-OMPI group, the OMPI group had a higher proportion of patients with a history of diabetes-related complications, a higher Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score, and lower levels of albumin(ALB), hematocrit(HCT), and homocysteine(HCY), with statistically significant differences(all P<0.05). Multivariate Logistic regression analysis showed that a history of diabetes-related complications(OR=2.481, 95%CI 1.011-6.087), higher APACHE Ⅱ score(OR=1.068, 95%CI 1.013-1.126),and higher HCY level(OR=1.735, 95%CI 1.436-2.096) were associated with an increased risk of OMPI in elderly patients with diabetes undergoing orotracheal intubation in the ICU(all P<0.05). Conversely, higher ALB level(OR=0.868, 95%CI 0.813-0.926) and higher HCT level(OR=0.775, 95%CI 0.668-0.899) were associated with a decreased risk of OMPI(all P<0.05). ROC analysis showed that the area under the curve(AUC) of the combined detection of a history of diabetes-related complications, APACHE Ⅱ score, ALB, HCT, and HCY levels for predicting OMPI in elderly patients with diabetes undergoing orotracheal intubation was 0.946(95%CI 0.919-0.986).Conclusion:A history of diabetes-related complications, the APACHE Ⅱ score, and levels of ALB, HCT, and HCY are independent influencing factors for OMPI in elderly patients with diabetes undergoing orotracheal intubation in the ICU. Clinically, corresponding measures can be taken based on these factors to effectively control and prevent the occurrence of OMPI.

参考文献：

[1] QIAN Y,LU H.Design and clinical application effect analysis of a new type of oral fluid suction device for patients with orotracheal intubation[J]. Contrast Medium Mol Imag,2022,2022:6057115.
[2] LI Q,SHI X,LU X,et al.Incidence of,and factors associated with,oral mucous membrane medical device-related pressure injury in critically ill patients with orotracheal intubation:a prospective cohort study[J]. BMJ Open,2025,15(6):e098114.
[3] CHEN Y,LU Y,YANG X H,et al.Characteristics and risk factors of oral endotracheal tube-related mucous membrane pressure injury in intensive care units[J]. Nurs Crit Care,2025,30(4):e70090.
[4] 庄朋,戴亚萍,钱丹,等.老年营养风险指数对ICU患者拔管后不良结局的预测价值:一项回顾性队列研究[J]. 现代医学,2024,52(8):1249-1255.
[5] GAO Z,ZHANG X,DENG Z,et al.ICU nurses' knowledge,attitudes,and practice of oral mucosal pressure injury towards patients with orotracheal intubation:a cross-sectional study[J]. BMC Nurs,2025,24(1):704.
[6] 兰雅智,刘颖,赵荣荣.重症脑卒中机械通气患者非计划性拔管预测因素[J]. 现代医学,2025,53(8):1272-1277.
[7] QIN L,YUN W,HANG C.Risk factors of endotracheal intubation-related pressure injury among patients admitted to the ICU[J]. Adv Skin Wound Care,2021,34(3):144-148.
[8] 张莹莹,张娟,冯敏,等.神经外科重症气管插管患者口腔黏膜压力性损伤预防管理的审查指标制订及障碍因素分析[J]. 护士进修杂志,2025,40(3):256-263.
[9] 张莹莹,徐博,陈成,等.神经重症气管插管患者口腔黏膜压力性损伤预防及管理的最佳证据总结[J]. 中华现代护理杂志,2024,30(12):1587-1595.
[10] 《中国老年型糖尿病防治临床指南》编写组.中国老年2型糖尿病防治临床指南(2022年版)[J]. 中国糖尿病杂志,2022,30(1):2-51.
[11] BRUN F K,FAGERTUN V H,LARSEN M H,et al.Comparison of Glasgow coma scale and full outline of unresponsiveness score to assess the level of consciousness in patients admitted to intensive care units and emergency departments:a quantitative systematic review[J]. Aust Crit Care,2025,38(1):101057.
[12] LIENGSWANGWONG W,SIRIWANNABHORN R,LEELA-AMORNSIN S,et al.Comparison of Modified Early Warning Score(MEWS),Simplified Acute Physiology Score Ⅱ(SAPS Ⅱ),Sequential Organ Failure Assessment(SOFA),and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) for early prediction of septic shock in diabetic patients in Emergency Departments[J]. BMC Emerg Med,2024,24(1):161.
[13] REAPER S,GREEN C,GUPTA S,et al.Inter-rater reliability of the Reaper Oral Mucosa Pressure Injury Scale(ROMPIS):a novel scale for the assessment of the severity of pressure injuries to the mouth and oral mucosa[J]. Aust Crit Care,2017,30(3):167-171.
[14] 辜甜田,黄光梅,张培,等.经口气管插管患者口腔黏膜压力性损伤风险预测模型的构建与验证[J]. 护理学杂志,2024,39(20):64-68.
[15] JIA L,DENG Y,XU Y,et al.Development and validation of a nomogram for oral mucosal membrane pressure injuries in ICU patients:a prospective cohort study[J]. J Clin Nurs,2024,33(10):4112-4123.
[16] CHEN R,ZHANG X,CHEN J.KAT8 knockdown reverses hucMSC senescence and enhances diabetic WoundHealing efficacy[J]. Exp Clin Endocrinol Diabetes,2025,133(9):441-452.
[17] GOU L,ZHANG Z,YONGDE A.Risk factors for medical device-related pressure injury in ICU patients:a systematic review and meta-analysis[J]. PLoS One,2023,18(6):e0287326.
[18] MOSER C H,PEELER A,LONG R,et al.Prevention of tracheostomy-related pressure injury:a systematic review and meta-analysis[J]. Am J Crit Care,2022,31(6):499-507.
[19] DE ASSIS I,ESTEVAM DOS SANTOS J,VALADARES SINICIO ABIB M,et al.Medical device-related pressure injury in an intensive care unit:a cross-sectional study[J]. Wound Manag Prev,2021,67(11):26-32.
[20] ZHANG N,LI Y,LI X,et al.Incidence of medical device-related pressure injuries:a meta-analysis[J]. Eur J Med Res,2024,29(1):425.
[21] DANG W,LIU Y,ZHOU Q,et al.Risk factors of medical device-related pressure injury in intensive care units[J]. J Clin Nurs,2022,31(9-10):1174-1183.
[22] JUNG Y K,HAHN H M,PARK D H.Factors influencing the severity of medical device-related pressure injuries:Pressure injury staging comparison[J]. Int Wound J,2023,20(7):2735-2741.
[23] CELIK S,TASKIN YILMAZ F,ALTAS G.Medical Device-Related Pressure injuries in adult intensive care units[J]. J Clin Nurs,2023,32(13-14):3863-3873.
[24] AYDIM KUDU A,TAŞDEMIR N,SÖNMEZ M.Incidence of medical device-related pressure injuries in the intensive care unit and related risk factors[J]. J Tissue Viability,2023,32(4):564-571.
[25] KIM C H,KIM M S,KANG M J,et al.Oral mucosa pressure ulcers in intensive care unit patients:a preliminary observational study of incidence and risk factors[J]. J Tissue Viability,2019,28(1):27-34.
[26] LEE H,CHOI S.Protocols and their effects for medical device-related pressure injury prevention among critically ill patients:a systematic review[J]. BMC Nurs,2024,23(1):403.

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